Wenjie Zhou ^1* Xueting Wang ² Jie Dan ¹ Mingjie Zhu ¹ Ming Li ¹ Ke Liu ¹ Qian Liao ¹ Yonghong Wang ^1*

• ¹ Department of Gastrointestinal Surgery, The People's Hospital of Leshan, Leshan, China
• ² Department of scientific research and teaching, The People's Hospital of Leshan, Leshan, China

The anastomosis method for laparoscopic left colectomy (LLC) remains inconclusive. Thus, a systematic review and meta-analysis was conducted aiming to compare the outcomes between intraperitoneal anastomosis (IPA) and extraperitoneal anastomosis (EPA)in LLC.Methods: PubMed, Embase, Cochrane Library, CNKI, and WanFangData were systematically searched for relevant literature. Literatures were screened independently by two groups, and data were extracted and evaluated for bias. Meta-analysis was performed using Revman5.4 software.Results: 12 studies with a total of 1278 patients were included in our meta-analysis. Compared with the EPA group, IPA group had less blood loss [OR =-20.32,95%CI (-27.98 ~12.65), p<0.00001], lower overall complication rate [OR=0.45, 95%CI (0.33 ~ 0.63), p<0.00001], fewer non-severe complications [OR=0.44, 95%CI (0.30 ~ 0.64), p<0.0001] and less surgical site infection (SSI) cases [OR=0.39, 95%CI (0.21-0.71), p=0.002]. While, a longer operation time appeared in the multi-center and propensity score matching ( PSM ) subgroups of the IPA group. Meanwhile, patients in the IPA group farted earlier and had shorter hospital stays. There were no significant differences between the two groups regarding severe complications, anastomose-related complications, postoperative blood transfusion, ileus, reoperation rate, time to stool, pathologic sample length, and lymph node dissection number.IPA seems more advantageous than EPA for patients receiving LCC in terms of complications and postoperative recovery, and has similar oncological outcomes. However, it may take longer time and may be more difficult to operate.